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   Table of Contents - Current issue
Coverpage
July-September 2021
Volume 29 | Issue 3
Page Nos. 151-197

Online since Thursday, July 29, 2021

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ORIGINAL ARTICLES  

Is unilateral local flap reconstruction sufficient in large myelomeningocele treatment? p. 151
Enver Arpaci
DOI:10.4103/tjps.tjps_100_20  
Objective: Skin flaps are acceptable methods for surgical treatment of myelomeningocele defects in the neonatal period. Skin flaps (e.g., V-Y advancement, rotation or transposition flaps) are often preferred bilaterally for closure of myelomeningocele defects. This study evaluated the adequacy of an alternative unilateral flap method called “ice cream-cone flap” in repairing large myelomeningocele defects. Patients and Methods: Fifteen newborns who were operated with “ice cream cone flap” due to myelomeningocele defect were evaluated retrospectively. Surgical repair was carried out within 1–3 days of birth. The defect sizes were ranging 10 cm × 8 cm to 4 cm × 4 cm diameter with the mean diameter of 7.2 cm × 5.4 cm. This technique is mainly based on the planning of unilateral advancement flap that resembles the shape of the defect. The technique includes additional procedures such as anchoring of a deepithelialized skin tissue to provide redistribution of the wound closure tension to the lateral side of the flap, and transposition of a skin protrusion to shorten the peripheral border length of the wound. Results: Durable, stable soft-tissue coverage of the defect was obtained in all patients. No hematoma, seroma, infection, and flap necrosis were observed during the postoperative follow-up period. Two patients had partial wound dehiscence which was healed with secondary wound healing. Conclusion: “Ice cream-cone flap” technique is fast, reliable, and easily performed and has the advantage of shorter operative time, less blood loss with minimal wound closure tension.
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The impact of obesity and nutrition habits on gynecomastia among Turkish adolescent males p. 156
Melekber Cavus Ozkan, Mustafa Taygun Oluklu
DOI:10.4103/tjps.tjps_118_20  
Introduction: Gynecomastia (GM) during adolescence is quite common and represents a serious psychological challenge among young males. Obesity is also one of the major public health problems affecting an important proportion of the population. We studied the relationship between nutritional habits, body mass index (BMI), and GM of adolescent males. Materials and Methods: In this study, we report an analysis of the incidence of GM and its relationship with nutrition habits and BMI among 511 randomly selected high-school students between 16 and 18 years of age from schools located in Pendik municipality of Istanbul. Results: We found the incidence of GM of 33.3% (n = 170) in 511 high-school boys of whom 24.8% (n = 127) were classified overweight or obese. Although the mean BMI for the entire group was within the normal range (22.8 ± 4.4), it was significantly higher in boys with GM compared to the boys without GM, 26.8 ± 4.5 vs. 20.7 ± 2.5, respectively (P < 0.001). In addition, boys with stage 2 and higher degree GM had higher BMI compared to those with stage 1 GM, 29.2 ± 4.5 vs. 24.8 ± 3.3, respectively (P < 0.001). We, thereby, observed a clear positive correlation between BMI and GM. Conclusion: GM in high-school boys is closely correlated with overweight and obesity. Precautions should be taken to increase awareness of this global health concern to develop comprehensive public health strategies to improve the prevention and management of obesity and related complications like GM.
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The effectiveness of rein flap technique in the cosmetic outcomes of rhinoplasty p. 162
Javad Rahmati, Ali Yavari, Omid Etemad
DOI:10.4103/tjps.tjps_122_20  
Background: The beauty of nasal tip is very important in septorhinoplasty surgeries. Unstable tip rotation may lead some problems in the outcome of this surgery or performing a repair surgery. Hence, using an appropriate method to save the tip rotation for the long term is considered. Materials and Methods: We studied 30 patients who underwent rhinoplasty in Imam Khomeini Hospital Complex of Tehran and Razi Hospital of Tehran and divided them equally into two groups of rein (case) and septocolumellar (control), randomly. Then, we evaluated the rotation and projection of the nasal tip (nasolabial, columellar-labial, and nasofacial angles) after 2 weeks and 6 months of the surgery. Results: In both groups, 80% and 20% of the patients were female and male, respectively. The reduction of the nasal projection (columellar-labial and nasofacial angles) and nasal rotation (nasolabial angle) was significant in both groups during 6 months after the surgery (P > 0.001) that showed reduction in the nasal projection and rotation after 6 months in both group. This reduction was not significant in the nasofacial and columellar-labial angles (nasal projection) among two groups. However, in the case of nasolabial, we found less reduction in the case group that explains significant relation (P = 0.03). Discussion: Using rein flap can be used as a proper way to save the tip rotation in the long term and could be used in the patients with droopy tip noses. Conclusion: Using rein flap in nasal tissue seems to be effective in providing a stable rotation and projection. This method can be considered as a good option for providing proper projection and rotation.
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Comparison of effectiveness of four facial masks used during the COVID-19 pandemic using indocyanine green and fluorescent angiography device: A plastic surgeon perspective p. 166
Erkan Deniz, Serhat Sibar, Ozgun Kilic, Suhan Ayhan
DOI:10.4103/tjps.tjps_105_20  
Background: The pandemic caused by the new type of coronavirus (coronavirus disease 2019) has led to a serious increase in the demand for personal protective equipment, especially the mask. Depending on the increasing demand, many types of masks have been used in the pandemic process between health-care professionals and the community. Aims and Objectives: In our study, it was planned to evaluate N95, green, white surgical, and fabric woven masks with a fluorescent angiography (SPY®) device for protection. Materials and Methods: To evaluate the effectiveness of the masks, models with and without mannequins are used. In both study models, indocyanine green was squeezed from the masks at a distance of 50 cm and the staining values of masks and mannequin faces were evaluated with fluorescent angiography (SPY®) device. Results: The most dyeing fabric was observed in the woven mask, while the least dyeing was observed in the N95 mask. In the model without mannequin, it was observed that the highest protection was in the N95 mask and the least protection was in the fabric woven mask. The most dyeing on the face was observed on the mannequin in which the woven mask was removed, and the least dyeing on the face was observed on the mannequin in which the N95 mask was removed. Green and white surgical masks were found to have similar protective rates. Conclusion: According to the results of this study, where the effectiveness of the mask was evaluated for the first time by using a fluorescent angiography (SPY®) device from a plastic surgery perspective, it was found that the N95 mask had the highest protection, the green and white surgical masks were similar, and the fabric woven mask had the least protection.
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Viability and durability of diced cartilage graft combined and formed with autologous blood fibrin (experimental study) p. 172
Tolga Aksan, Muhammed Besir Ozturk, Mehmet Ozer, Ilknur Mansuroglu, Mithat Akan
DOI:10.4103/tjps.tjps_129_20  
Introduction: Rhinoplasty constitutes an example wherein the various types of filling materials are used for nasal dorsal deformities. In this study, we took the advantage of a simplified procedure and used fibrin isolated from the coagulated peripheral blood of the experimental animal. Durability and viability of diced autologous cartilage grafts adhered to each other and formed using fibrin extracts were assessed experimentally in a rabbit model. Subjects and Methods: Diced cartilage graft (Group 1), block cartilage (Group 2), and fibrin adhered 0.5 mm diced cartilage graft (Group 3) were placed into subcutaneous pockets in the frontoparietal region of the same experimental animal. The grafts were excised at the end of 16 weeks. The excised grafts were macroscopically evaluated, and the final volumes and weights were measured. These measurements were compared to the initial values before implantation. Finally, the specimens were evaluated the histopathological examination. Results: In Group 1, 165% increase in weight and 56% increase in volume; in Group 2, 131% increase in weight and 81% increase in volume; finally in Group 3, 184% increase in weight and 68% increase in volume were seen. Although histological examination did not reveal any difference with regard to chondroid matrix score, metachromasia, vascularization, fibrosis, and inflammation we observed significantly higher cartilage proliferation score in Group 3. Conclusion: The results indicate that these grafts can be used efficiently, particularly in rhinoplasty procedures to correct nasal deformities.
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REVIEW ARTICLE Top

Reconstruction of mutilating injuries of the lower extremity – Surgical decision-making for the plastic surgeon p. 179
Cigdem Unal Gulmeden
DOI:10.4103/tjps.tjps_36_21  
High-energy traumas of the lower extremity caused by road accidents, gunshot injuries, or heavy construction equipment usually involve the bone and vascular structures as well as the soft tissues surrounding them. Reconstruction of these injuries may require teaming up with orthopedic and vascular surgeons to solve the dilemmas. Vascular evaluation and determination of the zone of injury is necessary to make the best possible reconstruction plan to achieve a functional and vascularized lower extremity. Although preoperative radiodiagnostic methods help in choosing the recipient vessels, flaps, and anastomotic technique, the ultimate decision is best made during surgery.
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CASE REPORTS Top

A practical tip for intraoperative perforator vessel selection: Portable thermal imaging p. 183
Daghan Dagdelen, Alper Aksoy, Erol Benlier
DOI:10.4103/tjps.tjps_104_20  
In planning of free-style free perforator flaps, relying on defined anatomical landmarks and preoperative imaging technologies is difficult to locate the perforating arteries. Situation gets more complicated when encountered multiple perforating arteries enter the small skin paddle. In these situations, the ideal perforator has to be selected mostly by clinical inspection. We would like to share our method for selecting the ideal perforating vessel in free-style perforator flaps by utilizing portable thermal camera, which may be a reliable intraoperative adjunct. An index digit soft-tissue reconstruction was planned with a free posterior interosseous artery flap. Preoperatively, two perforators were marked on intermuscular septum. After the skin island is elevated totally, both of the arteries were found to be of similar by means of caliber (<0.8 mm) and pulsation. A cold challenge test was applied to flap and a continuous video record with thermal camera was taken for 1 min. Video record shows that the dominant perforator is the distal one. Thus, the flap was raised based on distal perforator. Postoperative follow-up was uneventful. The portable thermal imaging is a low cost and readily accessible intraoperative adjunct for selecting the dominant perforator in free-style perforator free flaps.
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Single flap use for synchronous reconstruction of full-thickness upper and lower lip defects due to high-voltage electrical burn p. 186
Emrah Kagan Yasar, Can Ilker Demir, Samet Kaya, Murat Sahin Alagoz
DOI:10.4103/tjps.tjps_98_20  
High-voltage electric burns are a major source of morbidity and mortality, with significant socioeconomic and psychosocial implications. Electric burns rarely cause injury to atypical areas including the oral region with a reported incidence of 2.2%–3.5%. The ratio of burn area to total lip is critical for reconstruction options. Locally usable flap choices will be insufficient for subtotal defects of lips. Electrical burn of both lips is a rarely seen entity that is surgically challenging for both lip reconstruction with the minimum morbidity. It is known that a radial forearm free flap (RFFF) is suitable for total lip reconstruction and in addition, is one of the best options for simultaneous upper and lower lip reconstruction using only one RFFF. In this study, a case with both lower and upper lib necrosis, a rarely affected area due to high-voltage electrical burn, is presented. Reconstruction with a free radial forearm flap was successfully performed although the patient was presented in the subacute period as timing.
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A new utilization area of near-infrared fluorescence imaging: Hypothenar hammer syndrome p. 190
Seyda Guray Evin, Erden Erkut Erkol, Mustafa Sutcu, Zekeriya Tosun
DOI:10.4103/tjps.tjps_126_20  
Hypothenar hammer syndrome (HHS) is a rare traumatic vascular disease, which is characterized by pain and cold insensitivity in the areas fed by ulnar artery. Computerized tomography angiography (CTA) is the gold standard for the accurate diagnosis of it. Less invasive tests that are used to make decisions regarding the application of angiography, which is an invasive imaging method, have been reported in the literature. In this study, an indocyanine green-enhanced near-infrared fluorescence imaging system is used for the diagnosis of a patient with HHS who was not properly diagnosed with CTA. Although CTA is still considered as the gold standard for the diagnosis of upper extremity vascular insufficiencies, indocyanine green-enhanced fluorescence imaging, being an easily applicable and lacking of radiation exposure, should be considered first before CTA.
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LETTERS TO THE EDITOR Top

A rollboard for microvascular anastomosis: Cellulose eye spear p. 193
Burak Sercan Ercin, Burak Ozkan, Cagri A Uysal, Nilgun M Ertas
DOI:10.4103/tjps.tjps_97_20  
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COVID-19 pandemic and disciplinary approach in plastic, reconstructive, and esthetic surgery p. 195
Zeynep Altuntas, Majid Ismayilzade
DOI:10.4103/tjps.tjps_89_20  
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